Q & A with Eating Disorder Specialist Sari Fine Shepphird: Part 1

Sari Fine Shepphird, Ph.D, a Los Angeles clinical psychologist and eating disorder specialist, is the author of 100 Questions & Answers about Anorexia Nervosa. Psych Central contributor Margarita Tartakovsky, M.S., spoke with her about common myths surrounding anorexia, the media’s impact and healthy body image in kids. Be sure to check out Part 2 of the interview next week. For more information about Shepphird and her book, please visit her website.

Q: In your book, you discuss several prevailing myths, including: people choose to have anorexia; they’re just trying to get attention; anorexia is about vanity; a person can’t have anorexia if they eat three meals a day; and anorexia is just a phase. What kinds of myths do the media circulate?

A: One of the things, unfortunately, we see is that tabloid magazines or TV shows talk about anorexia as a tween or young celebrity’s way of getting attention. We see it portrayed as a lifestyle choice. However, anorexia is an illness, and no one would choose to have such a serious, debilitating mental disorder. We also see it portrayed as an extreme diet. However, anorexia isn’t just about food. It does involve disordered eating patterns, but there are other underlying issues. Anorexia has medical, psychological and social consequences — and most are devastating.

Corollary to that, if a celebrity has been underweight and then gains some weight, the media starts speculating about their massive weight gain or pregnancy. For example, the media will include a photo of a celebrity whose stomach is barely protruding and put her on “pregnancy watch.” This encourages the mindset that women are supposed to be too thin.

One of the worst myths about eating disorders is that you can tell if someone has an eating disorder just by looking at that person. If someone has anorexia, they often try to hide it through the clothes they wear. Or, they might drink a lot of water so their stomach looks bloated. Also, if a woman is tall or big-boned, you might not recognize that she has anorexia and individuals with bulimia might appear to be at a healthy weight. An individual might be underweight, but this doesn’t mean they have anorexia. If a person gains the weight back, it doesn’t mean they’re no longer in recovery, because weight restoration is one aspect of recovery from the illness.

Q: You list tips for distinguishing unhealthy exercise from healthy exercise and suggest people ask themselves: Am I exercising more than 5 days a week for more than one hour? Do I exercise in order to lose weight because I feel obligated to, or because I enjoy the activity? Do I try to squeeze in “hidden” exercise in order to compensate for calories consumed?

Interestingly, I’ve read these tips in various magazines, such as “walk an extra flight of stairs after eating a cookie.” What kind of potentially harmful advice have you observed?

A: There has been this new trend based on the book, Eat This, Not That: Dieticians are using the mass media as a tool to talk about which foods have less or more calories. Sometimes a dietician might say you should skip the thick crust pizza and have the thin crust instead, because you’ll have to run for two hours in order to burn it off. This isn’t true; it is a fallacy to say that one has to exercise for every calorie one consumes. Our bodies are naturally burning calories to take a breath, to wake up, to heal from a cold, to do regular activities in daily life that sustain us.

It is a myth to think that we need to burn off every calorie that we consume through exercise. If we want to maintain our weight, we actually only need to burn off whatever calories are in excess of our metabolic rate. A person can do an equation to calculate how many calories they should be eating per day in order to maintain a normal weight. To calculate one’s basal metabolic rate (BMR), one can use the following formula, but keep in mind that the formula is not exact as BMR can vary based on bone structure and amount of physical activity that one engages in. Or, visit the website links here or here.

Because of the way food is talked about, it is presented as something to fear, as though food is going to automatically cause weight gain. This is a dominant message in the media. The truth is that food sustains your life and lets you enjoy it.

People will avoid eating foods they like because those foods will make them fat. “If I eat that, I’ll have to exercise, so I’d rather just not eat it.” Exercise and food are presented as though both are equal and opposite enemies, when the truth is they’re both very valuable for our heart, brain, digestive system and our mental health to reduce feelings of depression and anxiety. Exercise is a positive thing that shouldn’t be feared or loathed. What we’re told in the media is that we should have a thin body above all. In order to get that thin body, we should be starving ourselves, through torturous exercise.

I have a lot of clients (and I think this is true for the general population), who will say, “I exercised for half an hour. It was kind of easy, and it didn’t hurt, so I don’t think it was enough.” Unless exercise hurts them and is so rigorous and vigorous that it feels like a punishment, they don’t feel like they’ve exercised enough. Exercise should be enjoyed. It is movement that we can appreciate. I would not recommend people choose forms of exercise that they hate. They’re less likely to do it and it ends up being something that brings discomfort and dread, not fulfillment.

The tabloid media ends up seeming like more of a source of authority than science! Celebrities often sell stories and ideas, so we hear about their weight-loss methods rather than what science says. Moderate exercise is the most beneficial. It has just as many benefits as rigorous exercise. Even 10 minutes, two times a day benefits the body. But instead we hear about celebrities who exercise in extreme heat, exercise until they feel like they’re going to drop, and we think that is what we should be striving for. But it contradicts what science says. The same is true for books, where the author tantalizes readers into learning about celebrity weight loss, when some of the tips aren’t a secret at all; they’re just common sense. Or, some aren’t proven by science and some are dangerous.

Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013 Published on PsychCentral.com. All rights reserved.

About Margarita Tartakovsky, M.S.

Margarita Tartakovsky, M.S. is an Associate Editor at Psych Central. She blogs regularly about body and self-image issues on her own blog, Weightless, and about creativity on her second blog Make a Mess.